Clin Endosc.  2020 Jul;53(4):458-465. 10.5946/ce.2019.121.

Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract

• Marcella C
• Sarwar S
• Ye H
• Shi RH

• KMID: 2504950
• DOI: http://doi.org/10.5946/ce.2019.121

Abstract

Background/Aims
Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract.
Methods
This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed.
Results
Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.43 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.29 years, 64.7±35.23 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis.
Conclusions
ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.

Keyword

Endoscopic full-thickness resection; Endoscopic submucosal dissection; Endoscopic treatment; Gastrointestinal stromal tumor; Submucosal tunneling endoscopic resection

Figure

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  Fig. 1. The flow diagram of the retrospective study. GIST, gastrointestinal stromal tumor.

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  Fig. 2. Endoscopic full-thickness resection treatment of the gastric stromal tumor. (A) A large gastrointestinal stromal tumor located at the fundus of the stomach by gastroscope. (B) Mucosal incision with a hook knife. (C) The lesion is dissected from the deeper fibers of the muscularis propria. (D) The tumor is completely resected, creating an artificial perforation. (E) The wound is closed with a nylon band and several clips. (F) The resected specimen.

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